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3/27/20182018 Regional WorkshopsALASKA IMMUNIZATIONWORKSHOPS 2018 Bethel: Yupiit Piciryarait Cultural Center March 5, afternoon session March 6, morning session Fairbanks: Public Health Center March 8, afternoon session March 9, morning session Utqiaġvik (Barrow) March 13, morning sessionAnnie Peterson-Lewis, RNNurse ConsultantSarah Aho, MPHEducation and Training ManagerKyong YuCDC Public Health Associate Program Kotzebue: Nullagvik Hotel March 15, morning and afternoon sessions Anchorage: Frontier Building Suite 100 March 20, morning and afternoon sessions Sitka: Harrigan Centennial Hall March 21, afternoon session March 22, morning session Webinar March 23Continuing Education Credits The Alaska Division of Public Health is approved as a providerof continuing nursing education by the Montana NursesAssociation, an accredited approver by the American NursesCredentialing Center’s Commission on Accreditation. In order to 3.5 contact hours you must: Attend at least 80% of this educational event Pass a posttest with at least 80% Submit a completed evaluation form at the end of the workshop.DisclosuresSpeakers have no financial conflict with manufacturers ofany product named in this presentationThe use of trade names and commercial sources duringthis presentation is for identification only, and does notimply endorsement by the presenter or the State ofAlaska Continuing education certificates will be provided electronicallyand will be sent by email after the date of the event. Community Health Aides can contact the ANTHC at CHAPCertification Board with any specific questions: (907)7293624/3642, chapcb@anthc.org.Agenda Warm Up Current Topics Mumps Influenza Pediatric VaccinesGetting to Know YouSome questions to get us started today!When you respond “yes” to a question, stand up or raise yourhand. Adolescent Vaccines Break Adult Vaccines Patient Interactions/Questions Break Program Requirements & Accountability Recognition Awards Quiz & Evaluation1
3/27/2018Have you lived in Alaska less than 3 years?What is your profession? Nurse (clinical) Community HealthAide Public Health Nurse OtherWhat type of organization do you work for?Does your organization provide vaccines? Private Public Health Tribal OtherState of AlaskaIs your organization currently enrolled toreceive state-supplied vaccines?Department of Healthand Social ServicesDivision of PublicHealthSection ofEpidemiologyImmunizationProgram2
3/27/2018Immunization Program Mission StatementThe mission of the Immunization Program is to prevent andcontrol vaccine preventable disease in Alaska by: Providing vaccines to health care providers at no charge Providing an immunization information system for use by health care providers and schools to maintain consolidated immunization recordsfor Alaskans of all agesEnsuring school and childcare compliance with immunizationregulationsProviding immunization education and training for health careproviders and the general publicCoordinating surveillance and control efforts for vaccine preventablediseasesSupporting efforts to increase vaccinations for all AlaskansImmunization Program ManagersSchool cineAssessmentProgram(AVAP)VaccineStorage IS)AlaskaImmunizationProgramEducation &TrainingVaccines ,Incentives,andeXchange(AFIX)PerinatalHepatitis BCaseManagementProgramReductions in vaccine preventablediseasesMatt Bobo Immunization Program ManagerLorraine Alfsen Field Operations Manager (VFC, School and Child CareCompliance)Tricia Franklin VacTrAK ManagerAnnie Peterson-Lewis Nurse ConsultantSarah Aho Education and Training ManagerAlicia Wieber Epidemiology Vaccine Depot ManagerVaccines Are Community HealthDiseases Haven’t Disappeared sease rates are lowin the U.S. This is not trueeverywhere in theworld3
3/27/2018Annual Economic Burden of VPDs, 2015Vaccine-preventable Disease in AlaskaVaccine-preventable Disease in AlaskaMUMPS UPDATEAn expanding outbreakAlaska Mumps Outbreak s/Mumps-surv.aspxAlaska Mumps Outbreak s/Mumps-surv.aspx4
3/27/2018Mumps Media CampaignVideo PSAWho gets MMR?Are your patients up-to-date on MMR? Tanya, a four year old in daycare who has one dose MMR Health care providers should ensure that all patients areat age 13 months Tanya’s Mom, Erica, who has only one documented MMRdose and volunteers in daycare twice a weekWho gets MMR? One of Tanya’s daycare friends gets mumps! Brandon, a daycare employee with two documented MMRdoses more than 5 years agoup-to-date on their MMR vaccination per the routineAdvisory Committee on Immunization Practices (ACIP)schedule. Two doses of MMR vaccine should be routinely administered to allchildren, starting with the first dose at age 12 through 15 monthsand the second dose at age 4 through 6 years before school entry. For persons who have received only one dose of MMR, a seconddose should be given to all school-age children aged 4 years andselect adults born during or after 1957 who are at high risk ofmumps exposure (i.e., healthcare personnel, international travelers,and students at post-high school educational institutions).Vaccination Recommendations For persons who participate in any group setting (e.g.,daycare, work, school, church) statewide where mumps iscurrently circulating (e.g., a recent case in a classmate ora coworker) OR for Anchorage residents who self-identifyas being Native Hawaiian or other Pacific Islander: A second dose of MMR is recommended for persons who have had Brandon’s sister, Monique, who does not work in thedaycare, but heard that there is a mumps outbreak andthat a third dose is recommendedone dose of MMR that was administered at least 4 weeks ago; thisincludes children aged 1–4 years. A third dose of MMR is recommended for persons who have had asecond dose that was administered at least 5 years ago.5
3/27/2018Vaccine RecommendationsWhat vaccine to give? Any Alaska resident who would like to have additional Bill is 24 years old and would like this third dose of MMR.protection against mumps during the current outbreakmay receive a third dose of MMR vaccine if it has been atleast 5 years since their second dose.He is insured through Medicaid. Robin is 55 years old and would like her second dose ofMMR. She doesn’t have insurance.Bus Ad in AnchorageVaccine Availability All children who meet the state recommendations for an additionaldose of MMR during the current outbreak are eligible to receive statesupplied MMR. Must choose appropriate eligibility category. Adults who meet the state recommendations for an additional dose ofMMR during the current outbreak may receive state-supplied MMR iftheir insurance carrier participates in the Alaska Vaccine AssessmentProgram (AVAP), or if they are uninsured and their medical providerhas opted-in to AVAP for uninsured adults. (http://akvaccine.org/) Adults who are not eligible for state-supplied MMR would need topurchase the vaccine or contact their carrier to see if it will becovered. Alaska Medicaid will cover recommended doses of MMR during thisoutbreak. Health care providers participating in AVAP should order sufficientquantities of MMR vaccine to assure an adequate supply.Reminders All patients should be counseled about self-isolation andbe excluded from work or school for 5 days after parotitisonset. Patients should be informed that they may be contactedby public health for a follow-up interview. All suspect and confirmed mumps infections arereportable to the SOE at 907-269-8000 during businesshours or by fax using the Infectious Disease Report Form(907-563-7868, 24-hours a day). Testing information through Public Health is available onthe SOE Mumps Webpage:http://www.mumps.dhss.alaska.gov6
3/27/20181918 Flu Pandemic 100 years ago Estimated to have: Infected one third of theworld’s population ( 500million) Caused at least 50million ticles/PMC3291398/1918 Flu Pandemic2017-2018 Flu Season (CDC) Had high mortality in: healthy young adults(age 20-40) children age 5 yrs adults age 60 yrs 128 pediatric deaths Most children who diedof the flu had not beenvaccinated. Region 4 – Highestpediatric deaths (33) Made its way to even AL, FL, GA, KY, MS, NC,the most remote partsof AlaskaSC, 1398/U.S. Flu Surveillance ://www.cdc.gov/flu/weekly/index.htmAlaska Flu s/influenza/influenza.aspx7
3/27/2018Alaska Flu SurveillanceAnnual Flu Vaccine Flu viruses areconstantly changing. Annual influenzavaccination isrecommended for allpersons aged /fluhighrisk/index.htmlAnnual Flu VaccineAnnual Flu Vaccine People at high risk Helps to reduce the risk of flu by 40-60% among theoverall population.include: Helps to keep someone from getting sick Children 5, especially Reduces risk of flu-associated hospitalization 2 years oldAdults 65 years of agePregnant womenAmerican Indians andAlaskan NativesPeople who have certainchronic medicalconditions Causes antibodies to develop in the body about 2 weeksafter vaccination Seasonal flu activity often begins as early as October and cancontinue to occur as late as May. Recommend and ex.htmlAvailable Flu tmDosing for Children Thirteen different influenza vaccines available forpurchase during 2017-2018 season. Alaska Immunization Program supplies four presentationsthis t/Display?DocumentId isplay?DocumentId 19558
3/27/2018Eligibility for Flu VaccinesEligibility for Flu Vaccines Children All children eligible for state vaccine(VFC AVAP) Adults The same as all 2018eligibility guidelines. TRICARE is participatingin AVAP. Adults with TRICARE mayreceive 2018 AVAPvaccines. Medicare and Medicaidare not participating.Live Attenuated Influenza Vaccine (LAIV)Is there a preferred flu vaccine? Sold under the trade There is no preferential recommendation for one fluvaccine over another for the 2018-19 season.name FluMistQuadrivalent LAIV should not beused during the 201718 season ACIP approved fornext son/flu-season-2017-2018.htmPreventing the FluCase Study 1 Avoid close contact A mother brings her 3 year old daughter for an influenza Stay home when you are sick Cover your mouth and nose Clean your hands Avoid touching your eyes, nose, or mouth Practice other good health habitsvaccine today. She has never received an influenzavaccine before. Which of the following is the mostappropriate? 1. Administer a single dose of inactivated influenza vaccine (IIV)now and a second dose in one month. 2. Administer a single dose of either IIV or LAIV, and a second dosein one month. 3. Administer a single dose of IIV or LAIV, and no second dose isneeded.9
3/27/2018Case Study 2Case Study 3 Optimus, who is recommended 2 doses, received only A 70 year old male is getting vaccinated for the flu. Whichone 0.25 mL flu shot at 6 months of age. At 5 years of age, he received one 0.5 mL flu shot. Optimus has come in this season, at 7 years of age, forthe flu shot. Which of the following is true? 1. Optimus is recommended 1 dose.vaccine(s) from below is recommended? Any of the last three Is high-dose preferred for older adults? Studies indicated that it was more effective, but CDC and ACIPhave not expressed a preference. 2. Optimus is recommended 2 doses.Case Study 4 An 18 year old female, who is Alaska Native, has come into get a flu shot. She only has Medicaid. Which of thefollowing is true? 1. She is eligible for state-supplied vaccine. 2. She is ineligible for state-supplied vaccine. What is her eligibility category? 1. VFC Medicaid Eligible 2. VFC American Indian/Alaska Native (AI/AN) 3. State VaccineState-supplied Vaccines for ChildrenPEDIATRICIMMUNIZATIONSWelcomeEligibility MattersAlaska is a universal coverage state for childrenDose levelaccountability CDC requiredAll children in Alaska are eligible for vaccinesprovided by the stateAccuratedocumentationof eligibilityIncorrecteligibilitydocumentation provides datarequired forcontinued funding may constitutefraud and abuseState-suppliedvaccine - toproviders atNO charge VFC (the Vaccines for Children Program) State Vaccine (AVAP and Public Health Service Act, Section 317)10
3/27/2018What are the Pediatric Vaccines?2018 Childhood Immunization Schedule Learner should be able to List Pediatric vaccines List the recommended scheduleBirthVACCINESAGEVaccine Preventable DiseasesThis patient is suffering from a cancercaused by a VPD We have vaccines to fight over 15 Preventable DiseasesIACACIP Update regarding Birth Dose ofHepatitis B Vaccine1st Cancer-Preventing VaccineHepatitis B VaccineThe ACIPrecommendsUniversal HepatitisB Birth dosefor ALL infantswithin 24 hours ofbirthAdminister at BirthSurvives on surfaces forPatient Education Prevents Mother-to-child transmission Household transmission Do not share toothbrushes, Do not chew food to feedto babies11
3/27/2018Alaska Birth Dose Honoree2018 UpdatesMMR -3rd doseInfluenza673rd Medical Group, JBER, AKReported a coverage rate of 93% from1/1/2014 to 12/31/2014 and 93% from6/1/2015 to 6/1/2016 and 97% from6/1/2016 to 5/31/2017.IPV/OPVPneumococcal VaccineRotavirusMeningococcal VaccineImmunization Action ose/honorees.asp#ak2018 UpdatesWhat are the Pediatric Vaccines?MMR -3rd dose B DR HIP MNEMONIC ACIP recommended a 3rd dose during outbreaksVery DIM Between 4&6pm One MAD HPV Tada! Human Men Men BoostedInfluenza ACIP voted to include nasal spray flu vaccine 2018-2019AGEBirthIPV/OPVVACCINES Clarification on catch-up for 4yrs Updated guidance for documented oral polioPneumococcal Vaccine Additional dose may be needed for chronic diseasesRotavirus 1st and last doses added to rotavirus vaccine rowMeningococcal Vaccine Footnote to separate MenACWY and MenB vaccinesUSMLEPediatric VaccinesPediatric Vaccines Add 2, 4, 6 months, 1-1.5 years, 4-6 years, 11-12 years, Under 2 months, “B D R H I P” 2nd row has HepB vaccine for the Birth dose Under 4 months, “4 D R H I P”16-18 years in the remaining row cellsVACCINESHepB2461-1.54-611-12 .54-611-12 16-1812
3/27/2018Pediatric VaccinesPediatric Vaccines Under 6 months, “B D R H I P IN 6 months” In 1-1.5 years column “One MAD HPV”AGEBirth2HepBB461-1.54-611-12 IPPPVPPPVACCINESVACCINESAGE4-611-12 16-18InInPediatric Vaccines In 4-6 years column In 11-12 years column “VERY DIM Between 4 and 6 pm” Tada! HumanBirth2BB461-1.54-6BMVery11-12 ACCINESAGEPediatric VaccinesInIIIPPPPV16-18InPediatric VaccinesMNEMONIC for Vaccines In 16-18 years column Men USMLE13
3/27/2018Childhood Immunization Schedule 2018Combination VaccinesImmunization Schedule – Combo VaccinesCase Study Athena Athena is an 18 month old & behind on the DTaP; shereceived Pediarix at 3 months, 6 months, & 12 months Can Athena receive Pediarix for the next dose?1. HepB @4mos not nec if birth dose received-may be included as part of combo; 2. 6mo dose not needed if Rotarix used for both 1&2; 3. 6mo Hib not indicated ifPedvaxHIB used for both; 4. Flu avail in thimerosal-free; 5. Licensed for 4-6yo; 6. MMR Varicella @12-15mosCase Study Athena AnswerCase Study Kacey No Athena should not receive Pediarix for the next dose.Why not? Pediarix is licensed by FDA for only the first 3 dosesof DTaP series It should NOT be given to children than 6 weeks It should NOT be given to children 7 yearsKacey, 18 month old (DOB 8/1/16), received the Hepatitis B vaccineat birth & two doses of Pediarix at 3 and 12 mos.Can Kacey receive a 3rd dose of Pediarix?14
3/27/2018Case Study Kacey AnswerCase Study DelaneyKacey, 18 month old received two doses of Pediarix after the Birthdose of the Hepatitis BPediarix is licensed for doses 1, 2, and 3 of the DTaP primary seriesthrough age 6Answer: Yes, Kacey can receivea 3rd dose of Pediarix.Delaney is 9 years old. Two DTaP & 1 Tdap werereceived. Is DTaP/Tdap needed next/when, if any?Would it DT or Td?Case Study Delaney AnswerCase Study Nicholai 9 year old DTaP/Tdap Question with 2 valid doses at age Nicholai, an 11 year old, is here in the clinic. You notice he6 and 7 years, one invalid dose The recommendation: children to receive a single dose ofreceived a Tdap at age 7 years old. Then he had a doseof Td 6 months after the Tdap. Does Nicholai need a Tdapor Td now? Or is he done?Tdap for children ages 7-10 years who did not finish aminimum 3-dose series of pertussis-containing vaccinesbefore their 7th birthday. Delaney will receive Tdap Pay attention-Catch-Up Schedules Follow - minimum intervalsCase Study Nicholai AnswerHib Vaccines Look at the Footnote for Tetanus, diphtheria, and acellularpertussis (Tdap) vaccine, 7 years for catch-upvaccination) Children 7-10 years who receive Tdap may receive theroutine Tdap dose at 11-12 years Answer: Nicholai may receive Tdap now15
3/27/2018Case Study Zoey AnswerCase Study Zoey Zoey received ActHIB at 2 months then PedvaxHIB at 5months If different brands of Hib vaccine used 3rd primary dose of either vaccine The schedule: 8 weeks from the previous dose at 7months, since her 2nd one was at 5 months A 2-dose primary schedule used only when both doses are PedvaxHIB What should Zoey receive next and when?Helpful ENT VACCINESYoung Adults Age 11 through 18 YearsChildren’sHospital ofPhiladelphiaNationalFoundationfor InfectiousDiseasesState-supplied Vaccines for ChildrenState VaccineAlaska universal coverage state childrenAll children in Alaska eligible for vaccinesprovided by the stateAVAP assessmentpayments collected fromhealth plans &insurersPublic HealthService Act,Section 317,authorizes federal purchaseof vaccinesFunds support purchase ofvaccines AlaskaImmunizationProgram VFC (the Vaccines for Children Program) State Vaccine (AVAP)16
3/27/2018Eligibility MattersDose levelaccountability CDC requiredAdolescent ImmunizationsIncorrect eligibilitydocumentation may constitutefraud & abuseAdolescent TriadNIS DataEstimated adolescent HPVvaccination rates in Alaska, NIS,2008-2016Estimated adolescentvaccination rates for Tdap andMenACWY in Alaska, NIS,2008-201670906040HPV1-F30HPV UTD-FHPV1-M20HPV UTD-MEstimated CoverageEstimated Coverage8050706050 1 Tdap40 1 0800YearHUMAN PAPILLOMAVIRUSESHPV ScheduleHPV – Common family of viruses infecting epithelial cells79 million are infected with HPV14 million – newly infected each year17
3/27/2018Case Study DonnyWhen can HPV be started and what is the doseschedule? Donny (a 17 year old) started HPV vaccine at 15years.Case Study Donny (Answer) Donny needs to complete 3 doses because hestarted the vaccine at 15 years of age The schedule is 0, 2, 6 Does Donny only require 2 doses?Case Study MavisMavis, a16 year old, had the first HPVvaccine at 9 years & then had the secondone 4 months later. Is Mavis done with the HPV series?Case Study MaggieMaggie, a 13 year old Alaska Native, hasMedicaid and had her first dose of HPV 2 yearsago.Case Study Mavis (Answer)She is not done with series. Mavis will need 1more HPV vaccineMinimum interval was not met between 1st & 2nddoseCase Study Maggie (Answer)Maggie only needs ONE more HPVdose!How many more doses of HPV does she need?What is her eligibility?Maggie - VFC MedicaidThis costs her family less because theadministration fee billed to Medicaid18
3/27/2018Meningococcal VaccinesBacterial Infection Neisseria meningitidisUnpredictable Sporadic Occurs among previously healthy children/adolescents Serious Outcomes Meningitis Meningococcemia (bloodstream infection) Death rate 10-15% even with antibiotic therapy People who survive » suffer lifelong disability (amputation, hearingloss, brain damage)RAPID PROGRESSION Death may occur within 24 hrsMeningococcal VaccinesMeningococcal Vaccine Meningococcal polysaccharides, conjugates & proteins Recommendations A,C,W, Y MenomuneMenB-FHbpTrumenbaMenB-4CBexeroRoutine Recommendations-Quadrivalent MeningococcalConjugate Vaccine (MenACWY)Preteens 11 through 12 yrsGive 1 dose of 2-dose MenACWY series (dose 2 at 16yrs)Teens 13 through 15 yrsGive catch-up dose #1 of 2-dose MenACWY series (dose 2 at 16yrs)Teens at age 16 yrsGive dose #2 MenACWY. (Separate fr dose #1 by at least 8 wks)Catch-up teens 17 through 18 yrsIf dose #2 not given at 16 yrs, give dose #2 of MenACWY as catch-upCatch-up teens 16 through 18 yrsIf no hx of prior vaccine MenACWY, give 1 dose MenACWY1st yr college students, 19 yrsthrough 21 yrs, living residencehallsIf no hx of prior vaccine MenACWY, give 1 dose MenACWY. If hx of 1dose MenACWY given when younger than 16 yrs, give dose #2Immunization Action CoalitionCase Study TomCase Study Tom (Answers)Tom has coverage through Aetna but has notmet the deductible or met copays. He is up todate on all of his childhood vaccinations.Tom is ready to start the adolescentvaccine triadAt 11 years old, what will you recommendtoday? 1 dose of Tdap 1 dose of Meningococcal vaccine 1 dose of HPV vaccineWhat is Tom’s eligibility?Tom has private insurance and iseligible for state vaccine, even if hehasn’t met the deductible or copays.19
3/27/2018Case Study ErikaCase Study Erika (Answer)Erika received two doses of meningococcalvaccine before age 16 years, does Erikaneed a booster now at age 16?An adolescent who received a meningococcalvaccine dose at age 13 – 15 yearsBooster dose needed between 16 – 18 years If a first dose was received after 16th birthday Is a booster dose recommended?No Booster dose needed ifreceived 16 yearsMenB SchedulingMenB VaccineMenB-FHbpTrumenbaMenB-4CBexseroTrumenba 2-dose 3-dose Two MenB vaccines are currently licensed The two are not interchangeable – SAME MUST BE USED TOCOMPLETE THE SERIES ACIP Recommendation 16-23 years State-supplied - BexseroCase Study Alek Alek received Trumenba/MenB-FHbp, 2 months ago andBexsero/MenB-4C yesterday Should Alek complete the series with Trumenba or withBexsero or is he complete? What are the intervals?0 and 6 months0, 1-2, and 6 monthsBexsero 2-dose0, 1 monthCase Study Alek (Answers)Either vaccine can be use to complete the series If Bexsero is chosen: 2nd and final dose at least 1 mo after yesterday’s dose If Trumenba is chosen: 2nd and final dose at least 5 months after yesterday’s dose If at increased risk Trumenba 2nd dose 1 month after yesterday’s dose 3rd dose 4 months after the second Trumenba dose20
3/27/2018Case Study LorenCase Study Loren (Answer)Loren is a 16 year old with a Tdap documented in2009 (at 8 years old) & Td 1/2015 (at 14 years old) &another Td 2/2015 (at 14 years old)Does Loren need another dose?* The third dose is invalid Another Td is neededChildren, 7 yrs & adults with NO history of receivingtetanus-containing vaccine or if vaccine history unknown:Receive 3-dose seriesTdap for the 1st doseFollowed by Td, 4 weeks later for 2nd6 months later for 3rdTdap can be substituted for one of the3 doses preferably the 1stAlaska Immunization ProgramAnnie Peterson-Lewis, RNNurse ovAdult Vaccines Do you vaccinateadults? How do you track adultvaccines?ADULT VACCINESAges 19 and Older21
3/27/2018Standards for Adult Immunization PracticeAdult Vaccines What vaccines do adults need?Adult Vaccine SchedulePneumococcal vaccination coverage among adults 65 years, by State, HHSRegion, and the United States, BRFSS, 2016Alaska:69.8%Case Study: AlicePneumococcal Vaccination Alice just turned 65 What pneumococcalvaccines should shereceive? Two vaccines recommended for all adults 65 and older Pneumococcal conjugate vaccine (PCV13) Pneumococcal polysaccharide vaccine (PPSV23) Supplied by the Alaska Immunization Program Recommended for adults 19-64 who: Have certain health conditions, including asthma Are taking medications that lower the body’s resistance to infection Who are immunocompromised Who smoke cigarettes22
3/27/2018Alice: Pneumococcal Vaccine Alice should receivePCV13 first One year later, shecan receive PPSV23 What other vaccinescan Alice receive?ShingrixRecommendations Two doses Doses separated by 2 to 6months Recommended for adultsaged 50 and olderHerpes Zoster Virus Vaccine The ACIP made three new recommendations inOctober 2017 regarding Shingrix: Recombinant zoster vaccine (Shingrix) is recommendedfor the prevention of herpes zoster forimmunocompetent adults aged 50 years and greater. Shingrix is recommended for immunocompetent adultswho previously received Zostavax. Shingrix is preferred over Zostavax.What do you do?Storage Store refrigerated Jim received Zostavax at age 62 and has heard that thereis a new shingles vaccine. He is now 64. Jim has BlueCross/Blue Shield insurance. What do you tell him?between 2 and 8 C (36 and 46 F) Adjuvant suspensioncomponent vials Lyophilized glycoprotein Eantigen component vialsVaccination RecommendationsShingrix Reconstitution If patient has previously been vaccinated with Zostavax,Shingrix should not be given less than two monthsfollowing Zostavax. Jim can receive Shingrix!23
3/27/2018Administration InstructionsState-supplied Vaccines for Adults Intramuscular injection The Alaska Immunization Program offers select vaccinesto eligible adults After reconstitution, The Alaska Vaccine Assessment Program (AVAP) is aadminister immediatelyor store refrigeratedand use within 6 hoursfunding mechanism that enables adult coverage AVAP is funded through a combination of participatingpayers and opt in medical providersAdult State-supplied VaccinesAdult EligibilityAdult VaccinesBrand NameAge Criteria (in years)9vHPVGardasil 9Females 19 through 26; males19 through 21; high risk* males22 through 26 Adults are 19 and olderInfluenzaVaries19 Adults are NOT Vaccine for Children (VFC)MCV4Menactra19 through 20MenB**Bexsero19 through 20PPSV23 (Pneumoncoccalpolysaccharide)Pneumovax 2319 Td (Tetanus/Diphtheria)Tenivac19 Tdap (Tetanus/ Diphtheria/acellularPertussis)BOOSTRIX19 Zoster (shingles)Zostravax/Shingrix60 through 64, or 50 through 64eligible Adults may be eligible for state vaccine*High risk males include either men who have sex with men (MSM) or who have an immunocompromisingcondition.** Limited availability for high risk groups, which include those with persistent complement componentdeficiencies, anatomic or functional asplenia, microbiologist working with serogroup B meningitis, andpopulations at risk of outbreaks.MMR in outbreak situationsEligibility MattersWho can receive state vaccine for adults? Program requirement to correctly document nsurance/Provider Statuswith AVAPHL7CodeAdministrationFee Bill toVaccineAdministrationFee CapVaccineCost Bill toStateVaccine*InsuredPrivate insuranceor TRICAREV07InsuranceDetermined byinsuranceDo NOT billUninsuredHealth careprovider opts in forAVAPPatientDetermined byproviderDo NOT billUninsuredHealth careprovider does NOTopt in to AVAPPatientDetermined byproviderDeterminedby providerMedicareor MedicaidNot eligible forAVAPMedicare orMedicaidDetermined byMedicare orMedicaidDeterminedby Medicareor MedicaidIneligible(PrivateVaccine)V01AVAP Provider Opt InProvider Did Not Opt In Patients with an insurance Patients with an insurancecompany that is aparticipating payercompany that is aparticipating payer Uninsured adults*May appear as “state specific” or “local specific” eligibility in Electronic Health Records (EHR).24
3/27/20182018 AVAP Non-participating PayersDoes the patient meet the staterequired age criteria for the vaccine?Adult EligibilityYes Medicaid MedicareDoes the patient haveinsurance?Ineligible for statesupplied vaccineYesNoWhat type of insurance does thepatient have?Did the provider opt in for theiruninsured adults? Insurance plans that offer NO vaccinecoverage (State of Alaska Retiree Program)NoPrivate insuranceor TRICAREState vaccine AVAPMedicare orMedicaidYesNoState vaccine AVAPIneligbile for statesupplied vaccineIneligible for statesupplied vaccineCase Study: BenCase Study: Ben 25 year old Insured through Aetna Ben’s immunization history includes 2 doses HPV vaccine Healthy, no medical conditions Has a written, dated vaccination recordat 13 and 16 years of age. What should you do now? A. Do nothing. He has completed his HPV series. B. Give 1 dose of 9vHPV to complete the 3-dose series C. Restart the seriesACIP HPV ImmunizationRecommendationsCase Study: Julia Adults who initiated vaccination with 9vHPV, 4vHPV, or She had Tdap at age 11 and is 29 weeks pregnant with2vHPV Before their 15th birthday, are
CDC Public Health Associate Program 2018 Regional Workshops Bethel: Yupiit Piciryarait Cultural Center March 5, afternoon session March 6, morning session Fairbanks: Public Health Center March 8, afternoon session March 9, morning session Utqiaġvik (Barrow) March 13, morning session Kotzebue: Nullagvik Hotel
